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Quality of care: grandmother and grandaughter smiling together

Importance of wishes, beliefs and values in Best Interest decisions

A Best Interest decision (Section 4, Mental Capacity Act 2005) is a legally directed process that must be followed when a person has been assessed to lack capacity to make a specific decision at a specific time. By describing the process as ‘Best Interest’ it is purposeful reminder to all those involved that it is a decision that should be made in the Best Interest of the individual, and not any of the other involved parties.

With this in mind, it is therefore absolutely essential that the individual’s preferences, thoughts, wishes, values and beliefs are established before any Best Interest decision can be made.

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Loneliness and isolation: Elderly woman with head resting on her arms looking out of window.

Mental Capacity and Insight

The term ‘insight’ is often used by health and care professionals. For example, it may be recorded that a person ‘lacks insight’ into their toileting personal care needs. By which, the professional may be seeking to state (in a diplomatic way) that the person does not recognise when they have been incontinent.

The term is also used in other contexts in the care setting as well. For example, that a person may ‘lack insight’ into their mobility as a result of their dementia. By which the professional may be indicating that the individual’s falls are due to their impaired short-term memory and orientation, and that they are not able to process that their movements have deteriorated due to their Parkinson’s-related dementia which is causing them to have increased falls.

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Elderly man looking very concerned, while woman comforts him

Mental Capacity and the challenge of ‘silos’

In Court of Protection (CoP) cases across the past few years there has been increasing reference and cautionary notes regarding professionals working in ‘silos’. This has been discussed by professionals such as Local Government Lawyer (2020) and Barrister, and honorary KC, Alex Keene (2021, 2024). This is a very interesting and thought-provoking topic, that we will try to explain to give readers some important context.

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Elderly man walking through city using two walking sticks to support his mobility.

What is ‘salient information’?

When conducting a Mental Capacity Assessment it is vital to understand the salient information relevant to this case. Put simply, ‘salient information’ is the relevant information that is required in order for the relevant person to be able to demonstrate capacity for the specific decision being addressed.

To help illustrate this point, we have two case studies that consider two separate decisions: whether to install bed rails, and whether to smoke.

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Meeting between two people drinking hot drinks, over white table

Reflections on the NMCF Annual Report 2022–2023

The National Mental Capacity Forum (NMCF) is a working initiative between the Ministry of Justice (MoJ) and Department of Health and Social Care (DoHSC). The core purpose for the forum is to improve implementation of the Mental Capacity Act (2005), for which it has been releasing annual reports since 2016. The latest report for the period 2022-2023 has just been published (May 2024), and is recommended reading for anyone working in the field.

Read More »Reflections on the NMCF Annual Report 2022–2023